后腹腔镜与输尿管镜治疗输尿管上段结石的临床效果比较

Comparison between retroperitoneal laparoscopic ureterolithotomy and ureteroscopy lithotripsy for upper ureteral calculi

目的比较后腹腔镜输尿管切开取石术(retroperitoneal laparoscopic ureterolithotomy,RLUL)与输尿管镜(Ureteroscopy lithotripsy,URL)治疗输尿管上段结石的有效性及安全性。方法 2010年1月-2013年3月,对37例输尿管上段结石,17例采用腹腔镜治疗(腹腔镜组),20例采用输尿管镜治疗(输尿管镜组),比较2组的结石清除率及手术并发症等。结果腹腔镜组手术时间(50.0±17.0)min,术中出血量(25±10)mL,输尿管镜组分别为(65.0±12.0)min、(20±15)mL,腹腔镜组结石一次性取净率为100%(17/17);输尿管镜组结石一次性取净率为70.0%(14/20)。腹腔镜组在手术时间及术后血尿时间显著短于输尿管镜组(P<0.05),而结石净石率明显高于输尿管镜组(P<0.05)。腹腔镜组术后尿漏1例,并发症发生率5.8%(1/17);输尿管镜组1例出现较严重血尿,并发症发生率5%(1/20),两组并发症发生率差异无统计学意义(P>0.05)。结论腹腔镜输尿管切开取石术和输尿管镜碎石术在治疗输尿管上段结石上都具有较好的疗效与安全性,腹腔镜手术净石率高,手术时间及术后血尿时间较短,是处理复杂的输尿管上段结石的一种理想手术方法。

[ Objective ] To compare the efficacy and safety of retroperitoneal laparoscopie ureterolithotomy（RLUL） and Ureteroseopy lithotripsy（URL） for upper ureteral calculi. [ Methods ] From January 2010 to March 2013,a total of 37 patients with unilateral upper ureteral calculi were treated.Among the patients,17 patients received RLUL （RLUL Group）,and the other 20 patients underwent URL （URL Group）. The rates of stone clearance and operative complications were analyzed. [ Resluts ] The mean operation time in RLUL group was（50.0 ± 17.0） rain,blood loss was （25± 10） mL, which was significantly shorter than that of URL group（65.0 ± 12.0）min and （20 ± 15） mL（P〈0.05）.As compared with the URL Group, the RLUL Group showed a significantly reduction of stone clearance rate （RLUL group： 100% vs URL group： 70%, P〈0.05）.The incidences of postoperative were similar between the two groups（P〉0.05）. [ Conclusion ] Both RLUL and URL are effective and safe for upper ureteral ealeuli.IlLUL, whieh results in shorter operation time,higher rate of stone clearance, is a feasible lithotripsy.